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HomeMy WebLinkAbout030-2131-18-000 Wisconsl epartment of Commerce County: PRIVATE SEWAGE SYSTEM St. Croix S" -• Building Division INSPECTION REPORT Sanitary Permit No: \ 479320 �CJ G L INFORMATION (ATTACH TO PERMIT) State Plan ID No: AitHolderrs mation you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. (h Name: City Village X Township Parcel Tax No: Glen Johnson Construction I St. Joseph, Town of 030 - 2131 -18 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range/Map No: °J .90 g — 23.30.20.1072 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic ` d� �-• / Benchmark a �� 4 71 16 Alt. BM It Z ' ? � S • vmu A- C� ��e� Aeration Bldg. Sewer S• �� qy. 51 Holding St/Ht Inlet Z6 75 TANK SETBACK INFORMATION St/Ht Outlet Io.46 93.4 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet \ ` Septic ' / 16 / 16 / / Dt Bottom Dosing Header /Man. 7.3 9z•5 Aeration Dist. Pipe r G 12— Holding Bot. System 7 ! 1 Ol/ Final Grade QQ PUMP /SIPHON INFORMATION � 3 - Manufacturer GP and St Cover Z� --on. G'5 Model Number , o TDH Lift Friction Loss System Head DH Ft Forcemal Length Dia. to Well SOIL ABSORPTION SYSTEM BEDITRENCH Width / Length, No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth / DIMENSIONS IW + - ?Z Z f ".�^�Y-'C) � �- �. SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer. (� 1 � i INFORMATION CHAMBER OR o�A Type Of System: , w6/ ` / k UNIT g b Model Number: , DISTRIBUTION SYSTEM 4— ZZ -=- Header /Manifold J Distribution x Hole Size x Hole Spacing Vent to Air I take Pipes) ` \ SL ;_�l Length _ Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /S xx Mulched Bed/Trench Center /' Bed/Trench Edges Topsoil J Ned as L No No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: <:� / ( Z4 6 5 Inspection #2: Location: 147 Heritage Trail Hudson, WI 54016 (SW 1/4 SE 1/4 23 T30N R20W) Settler's Glen Lot 18 Parcel No: 23.30.20.1072 1.) Alt BM Description 2.) Bldg sewer length = j /5 - amount of cover = additional information. - — q i _ Plan revision Required? >Yes j No Use other side for L� 5 - - -- — Date V Insepctor's gnature Cert. No. SBD -6710 (R.3/97) Safety and Buildings Division County ir Alf 201 W , Washington Ave, , P.O. Box 716, scons►n Madt Sanitary Permit Number (to be filled in by ) Department of Commerce 8) F 9 t Sanitary Per ' A plie HOR State Plan I.D. Nu ber In accord with Comm 83.21, Wis. e t ' o iroKqlation you provide MY be used for secondary purpos pr t w, (1)(m) t_;KUIx t;OUN I r Project Address (if different than mailing address) I. Application Information - Please Print All Information Li �{�!r ; 'ly�,c. d > Property Owner's Na me _ _ _ -~ Parcel , Lot # Block # Property Owner's M ailing Address Property Location Q3t� - Z�,��- J ovi Cie, Statee '4, .e10 =/.,Section Zip Code Phone Number 1 4 - 467 `� ` r J 0 (circle II. Type of Building (check all that apply) f T � N; R_ 'S B o d 1 or 2 Famil y Dwelii ng 5d6w►r Subdivision Name CSM Number - Number of Bedrooms ❑ Public /Commercial - Describe Use _ � - / ❑ State Owned - Describe b (� � t!: oCity_ ❑Village ownship of �T III. Type oP Permit: (Check only one box on line A. Complete line B if applicable) _ _ A. — g New System ❑ Replacement System j ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System B • ❑ Permit Renewal RPemit Revision i ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration I Plumber Owner 6 �� 3� © ✓ IV. Type of POWTS System: (Check all that a l ,Non - Pres surized In- Gro und ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade Single Pass Sand Filter ❑ Constructed Wet ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter XL eaching Chamber s Pipe ❑ Odier (explain) V. Dispersal/Treatment Area Info on: u , I Y Design Flow (gpd) Design Soil Application Rate(g tspersal Area Proposed (st) Systr ern Elevation y- w4CJ 7 �/ ( VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Uru Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank Aerobic Treatment Unit i Dosing Chamber VII. Responsibility Statement 1 , the u ndersigned, assume responsibility for ' Ratio of the POWTS s hown on the at tached plans. Plumber's Na me (Print) Plumber's Si gnature MPRS Number Business Phone Number i Plumber's Addre ss (Street, City, State, Zip Code)) ! f VII . Count /De artment Use Onl Approved Disapproved Sanitary Permit Fee includes Groundwater D to iss ed Issuin gent Sign re o S Surcharge Fee) I F1 Owne cn R eason for Derna �� X Conditions of Approval /Reasons for Disapprnvat nQ I 11 SYSTEM OWNER: 1. Srplic tittle, efllwrit MW and disWW cd mast all be aefvI / maintained n per fnwwqemW plan provided by plumber. 2. AN suck ►egtti ww to must be mahtakted ss per applicable code / ordinances. + i Attach complete plans (to the County only) for the system on paper not less than 81/2 111 inches in size i f1TT /A/�/� /T I\� fl1A♦ Yo u� ifs 4 �3' T P L �3 c411 FvALIJAITION RFpna-r O V z- , r oga�or Dlviaten of Safety and Buildings in aocordahre with Comm 05, Wis. Adm. Coda Caxtty Adach camp(ete :ate plan on paper not less then 8112 x 11 Inches in size. Plan must - c o r include, but not limited to; vo llcal am horizontal reforoma point (DM), dh+3ctton am Paucd I.D. percent slope, scale or dimansiarms, north arrow, and location and distance to nearest road, Please print ail information. Reviewed try Date Paraonal Infonnatim yeu may be used far smondary Ourposm (vrlvany law, a. t 5-()d (1) (m)). property Owner ry� « O O. e&.v Prop" Location /� Govt. Lot tl S � �� 1/d %2- T3jO N R oW E (,a Proplmrty is Marling Address Lot # 8100* # 5ubd, Name ar CSM# d t#, r`ti 6pQ 9 - r5 ✓� City State 71P Code Phone N;imber Ory ❑ Vlllaga 2Town NeafQSt Road Now Canstrudlon Use: � Residential i Number of bedrooms "� Code derived design flow rate d r G __ _ GPO [� Replacemgrd C3 Public or commercial - Desc;nbe: Parent rno% W _( 4 5v\ Fbod Plam elevation if applicable ✓�-'� ft. General comments rjte G(c U and recemrimdatmm: E3 Ong Boring # Pit Ground surface elev. ft. Depth to limiting facto in. Sell ApplicaWn Rat2 Hod= Depth Dominant Color Redox Description Texture Structure Certutistence l Boundary Hoots GPDO in. Munsel Ou. Sz_ Cara. Color Gr. 92. Sh. "Effol •Eff#2 . b 1 6 v -17q — S cis Ci I Imo► l -- , Z I , Sodng # ❑ Boring / Pit Ground Surface elev. ft, Depth to limiting fader in. Bad � � Homo n Depth Domktant Color Redox Description Texture Structure Consistence Boundary Roots GPDAI In. Munsefl Qu. Sz. Cant. Color Gr. Sz 5h 'Eff#1 "Eff#2 l 0 -10 at r --- YK -fII- 4' 0 /e / G 5`� 1 • Effluent #1 = 500 a 301 220 nVL and T95 ?3o c 15o mgA- • Effluent K = 80U 30 mglL and TSS c 30 nVfL CST Name (Plea a."n altos CST Number Address Date EvaluW t Cavlici&F Teiephone Number 'l9 `' - �- ���'�IAD'z�e'r t WdST :60 SOOE 8d 'ON xlz.j WOad PrvpartyOwner 1 L7 rlG C �hCr� _ Parcel IDri to k -- Pag & Ej Boring Al �] Boring p it Ground surface elev. ft. Depth to pending fads in. Soil Beason RaW Morizon Depth Dominant Color Redox Description Texturo Sbucture Gorristence Boundary Rots OFoffP Ma in. nsell Qu- Sz. Cont. Color Or. Sz. Sh. �E i T1102 o'�{ 3/3 L 6 t� S i C7 lryl I �� � ❑ earing ❑ pit Around surface elsv, ft. Depth to krmiing factor . in. Soil Appllc=n Rate Haizan Depth dominant Color Rodox Des calptlan ToxuxQ StnuctUre Consistence Boundary Roots GPDO In. Munstall tau. Sz. Cord. Color Or. Sz. Sh, '�ftl 'Eft#2 ❑ SOON # ❑Boring ❑ Pit Ground surface eiev. -�-_ n. De pth to pmiting factor _ In. Sop fiaba Horizon Depth Dominant Color Redox Description. Texture 8tructy v Consistence Boundary Roos gpor In. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Lw 'E111102 ' Effluent #1 - B0D > 30 = 220 mgtL and TSS ?30 c 150 rnA ' Effluent N2 800 30 mg& and TSS c 30 rnglL The Departtueat of Commerce is an equal opportunity service provider and employer, if you need assistance to access scrviccs or treed material in an alternate format please contact the department at 606 - 266.3151 of TI'y 608 -264 -8777. tid Wd22:60 SOOE ea ' 'Ot-1 Xbj WOW T v 4 PAGE -3— NA ME C LOT# L EGAL DESCRIPTION 'la 1 14 S T N R E OR W r SCALE: 1" w ....._. HG SM I ELEVATION f �. P BM 1 DESCRIPTION nda� ISM 2 ELEVATION �-- BM 2 D ESCRIPTION SYSTEM ELEVATION SYSTEM TYPE (�oAUe,n -,uv.a a G SIGNATURE - DATE Id kdW :6G S0©PE 8a ' Ohl ) ij wodi I Safety and Buildings Division County W 2 Washington Ave., P.U, Box 7162 �t V ison, WI 53707 - 7162 Salutary Permit Number (w be filled in by Co.) Department of Commerce �./ Sanitary Permit App, 4si5. S Plan I.D. Num �^ In accord with Comm 83.21, Wis. Adm. Code, personal ou g�t�tde c secondary y purposes Privacy Lam) Pr ' A ma be used for y �U(1 1 ect Add (i different than mailing address) I. Application Information - Please Print All Information ZONING OFF1Ct -T Property wner's Na me _ -- P el # �T Block # Property Owner's M ailing Address Property Location Off_ Q r3 A /? a 1 f ; V 1 /4 '.6,Section ity, state Zip Code Phone Number r u�. A) n ^ (circle a T 2d N; R 11. Type of Building (check all that apply) 3 3 U0� wf C _ dmi Subdivision Name CSM Number P1 or 2 Family Dwelling - Number of Bedrooms _^ C' Public /Commercial - Describe Use __- Se BY.Jr e ❑ State Owned - Describe Use _ 4__ _ ❑City_ ❑Village Township of III. Type of Permit: (Check only one box on lin A. Com ete line B applicable) A ( N System Replacement System ❑ Treatmen oldi Tank keplacement Only ❑ Other Modification to Existing System B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of C) Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber net IV. Type of PO WTS System: (Check all that appl Non Pressurized In- Ground {J Mound > 24 in. of sui/bie t ❑ Mound \4i suitable soil ❑ At- Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑Pressurized In- Ground ❑ Hank ❑Peat F Aerobic Treatment Unit ❑ Recirculating Sand Filter Recirculating Synthetic Media Filter Leaching Cham Drip Line ss Pipe ❑ O n) _ V. Dispersal/Treatment Area Information: rt Design Flow (gpd) Design Soil Application Rate s Dis rsal Area Re uired (sf) Dis al Area Pro os (sf) System Elevation 8 FP � (8Pd � Pe 4 P Y �d � - � ge 3 VI. Tank Info Capacity in Total , umber ^ Manufacturer Prefab Site Steal Fiber Plastic Gallons Gallo F of Units Constructed Glass New Existing Crete Tanks Tanks I Septic or Holding Tank Aerobic Treatment Unit r I Dosing Chamber _� V. Responsibility Stateme I, tht er signed, assume respo nsibility For ' allation of the POWTS shown on the atta ed plans. Plumber's Na me (Print) P tber's Si gnature /b1PRS Number Business hone Number Plumber's Addre ss (Street, City, State, ip Co / f Sc a 77 j 11 VIII ount /Department Use Ohl �c Approved ❑ Disapproved Sanitary Permit Fee (includes GrourkWmer Date Issued Ts t ng Ageni Sig re o tamps) Surcharge Fee) � j V D ❑ Owner G Reason for Denial (iV` / LY. Conditio of AA rovat /Reasons for Di Mappj�v Y ,p�T f_ �07�C� /`ti f W(- �B/✓ SYSTEM W NE eptic tank, effluent filter and VA dispersal cell must all be serviced / maintained s er mana ement plan rovided b lumber. a VYU� -Qc-- 2. All setback requirements must be maintatne 3 as per applicable code /ordinances. 6 1 *R-t ,Svs mp ts,ns (to oe CWty only) r the - tepr o� not /2 x 1 i ches e corn_ / _��oQ ID ('11 rn12N (�/�'� s V r d• �� Ile c Ole;; 4 Goy � i I '• � �.� T -i � • it � � L� ', `�J�+�• � � Il 1� � T d7 . .7 �.n � T+.�r.:.. �ii..r��.r +. ` :. ^ � C r v.!'1 : � '.+ � , M�.w . a V :NT r IPE 12" MIN, ABOV (;BADE a ? ' 25' FRGS DOOR, WINNOW OREA1'�?ERDp,QaF FRESH AIR INTAKE JUNCTION' Box APPROVED , WITH CONDUIT 4WHOLE CGV � F +NISH£D GRADE W/ PADLOCK a �"C y RIS ER WARNYNG !ABEL _`...." 1 ,1 o ' N L+6 T �r f !� fi ♦aa. SEALS GAS- , Z AL M 7 TIGHT' I A SEAL PPROVED PPROVE�3 `-1 JOiNT$ WITH '1 PE 3' APP "VEO PIPE }PTO SIL 1 44" ON 3 ' ,onto M L C ' SOL Ili. SOIL PUMP OFF ELEV. FT. I € �+ kk RISER EX. r T J D 1 PERMITTED CNILY ' IF TANK MANU FA CT!J11EF 3" APPRvVED BEDDING UNDER TAB =K HAS APPROVAL CONtiRETE PAD SPECXFICA7 :CN5 S "TIC r DOSE 7ANY MAYJFACTJRER: h "UMBER 20SES PER DAY: pry! X g 5; SEPTIC 196 -d . GAL. LOSE VCUJ.uir INC::JDIN{; DOSE Oc.� ..w. Gp. «. FLOWBACK: e'$V GAu. %L4RM N'U ACTURER: CAPA'"TIES: A MODEL NJMSER: :NCKES a ��ww.. SWITCH TYPE: 2 INCHES x � 4 GA i . MAXUFACTVRER MODEL NUMBER- " � C � � Inns = - l ae GAL, SWITCH TYPE: :EUIRED DISC HARGE R-A T . G PUMP 6 ALARM VTX j NG AS PER I LHR !6.23 CRT: CAL JIFFE'RENCE 9E. Z&. OFF AND ."''ISTRIHUiION PIPE MINIMUM NETWORX SUPPLY PRESSURE 1 ^� rEET __..,. FEET F`ORCEMAIN k ��D T /?�Q •F ~, �F'R:C7:c7ty FACT FEET T=46L DYNAMIC HEAD : `ELT _' *TERNAL OF pUMp : , TX t . a•rF.R r-. L 1 Q W' I C .-AL Y 9 + r+ .[g000LDS PUMPS Submersible Effluent Pump 3871 EPO4 EP05 APPLICATIONS • Fu y submerged In high ■ EPOS Impeller. Thermoplas- ■ Bearings: Upper and lower Specifically designed for the g turbine oil for tic enclosed design for heavy duty ball bearing following cues: lubrication and efficient Improved performance. construction. heat transfer. 0 Casing and Base: Rugged • Effluent systems • Homes Available for automatic and thermoplastic design provides AGENCY LISTING • Farms superior strength and corrosion manual operation, Auto- resistance. v "'�' s ' uy00 �' 0 " • Heavy duty sump med models Include a Motor Housin • Water transfer Medtattital Float Switch 9' Cast iron (CSA listed model numbers end • Dewatering assembled and preset at the for efficient heat transfer, in "F" or "C ".) 1160my, strength, and durability. SPECIFICATIONS 9 Motor Cover: Thermoplastic Goads Pumps is 'so gout Registered. • Solids handling capabil FEATURES Cover with integral handle and �9 pa �y: float switch attachment points. 3 / maximum. ■ EPO4 Impeller. Thermoplas- 0 Power CaW: Severe duty • Capacities: up to 60 GPM. tic Semi-open design with rated oil and water resistant. • Total heads: up to 31 feet. pump out vanes for mechanical • Discharge size. 1 `h" NPT. seal protection. • Mechanical seal: carbon - rotary/ceramic- stationary, BONA -N elastomers. • Temperature: 104°F (4M continuous METERS FEET 1 60 intermittent, r o • Fasteners: 300 series Stdirile55 Steel. 9 30i I .� • Capable of running dry without damage to $ �_.. 2s rr components. p _ 4 7 ..� Motor: s _. -- • EPO4 Single phase: 0.4 NP, zo .. 115 or 230 V, 60 Hz, 1550 S RPM, built in overload with automatic reset. Gr is EPOS • EP05 Single phase: 0,5 NQ, 115 V, 60 Hz, 1550 RPM, _.. __. . 3 10..._. built in overload with EPO4 automatic reset. z • Power cord: 10 foot 5 standard length, 16/3 1. STOW with three prong grounding plug. Optional 20 0 °o 'O 20 30 __ 40 50 GPM foot length, 16/3 S1TW with three prong grounding plug ` -' (standard on EPOS 0 2 4 6 a 10 12 m) /h ca+►ac1TY Goulds P ump s Q 2000 Goulds Pumps ITT Indu Effective February, 2000 83671 STANDARD CHAMBER Oulli Standard Chamber — - -- - - -- -- -- 48" �� -- (EFFECTIVE LENGTH) i 1�2 01 1 1 8" -- -- 34' SIDE VIEW SECTION VIEW MultiPort End Cap { - - -- — �� _ - -- j 1 6" —! —" - -- — - - --,. SIDE VIEW TOP VIEW FRONT VIEW �� Qui ck4 Standard =Ghamble: Nominal S�ecihcahons �� � "� "s ` �����`�'`� _ � t i4lttlitP�pri:Ettd Cap�t�ominai S�ecificatfons�'`� .� � j3y� Effective Length 48" Invert Height 8" or 1.25" Invert Height 8" INFIL TRATOR SYSTEMS. WC STA NRWR D LIMITED WARRANT (al Tito structural ir0egiih of each cha nber, and Pale, wedge and ollior ace wfvv manubzc.ldrarf by IuGlhei, 'Units J, W,i" ulstal.od & v qw aled rn a I(.v:r.fwtd of an onsite sr/ptic system in socordi will In9Xraldr's inslmciion3, : wa,rantud to too ongulei pullhaw, ('I "gavelf dafeCllye materials Ar'd — kITI,vrsh it for one yoar Iran the date that tile septic pennl isa for is uHd the swill( system ealaolng'he Qni-3; p,,wded, however, that ,1 n ,nentic permit is not iemtred by apprlcablo law, the wananly paned w,: begin on up Iho date that Inslakdtan Ot the sal Al. system oommHr>i rxer o its warranty rigMe Hi rrrus rot fy t4ihafa in carding al as Corporate. Haa 1 aua,krs !r DJ Saybrook Cgmechcul wli m fitlean (15) fay Cf the aaege i dcit l tr At for will suli epac %nlr. t Jnfs for Untt, detarrmretl by Inidbalw to no cavern! by this jmited Wananly. f I I S . • al r s I ah l It spec. tic; a Ludes the cost o1 runruvd and/or inmallar" n o r the lln t O R c r'L " i NA bht M I IN NTIES O F MEnC. AHE - XgL4r IVL IIX'RFA ti? li� VVARRANfIES'Nlf IHESf'tCT SYSTEMS INC rr 1 C 1NI'. F IM. N I U1 UI 1 'Ni= I!O IMPLIED 'EU w-i iFANTIES OF MFRC'HAN I )I 74bt I fY GH I NFy f� A !! IWr_ A R .IRFOSE (! t I ! Hod W u i- shwa l o — i, any p' d t I Ino c.hunlh., „ystem l anufae lurau ay . yon other flan Ir fft ,slur. Ins L rated Warrardy dne9 lit Cx! rd to rn "M wI uon, ,x,uent vi, special or indirHCi dama;Tos Inl that' shall not b twx pena!t'cs or 4quirl.MW (lama 3as including bss of Environmental Onsite Wastewater Sorutfons" it "duct' n and i aw i , .ntwt aril materials, uveihead COSIS, of other los' S or expenses marred b h 3 Holder nr any thircl party Specifically r CI air from L Initod Warranty coverage ere damage to l4e Units due tc v6inary wear and !tier alter anon, acclutenT, mfstse, abuse or neglect of t i Urns; the Un being subl%ted to vehicle traffic or other conditions W are not pe rrwtnd by the instaialm i1 stn:ctirxls failure to maintain :he 6 Business Park Road • P O. Box 768 n, nlmum ground covers set loth in the installation instrtie lass; the placement of improper mailer:a info the system corltaAng the Unis; failure o' ,.I pp,,,, the Units or the Sept Sys!ern duo to improper siting or Improper siring, e"Cessive water usage, Improper grogi disposal, or tmpmpor operation; or Old Sayb CT 06475 any nlhYr event not caused by Infiltrator. This Limited Warranty shall be voic if the Holder falls to cdrroy with NI of the terms set forth in this Ufniled War,ar,! 860 -577 -7000 •FAX 860 -577 -7001 rurthe', in no —l540 mlbllrator be responsible for arty loss or damage tp Me Holdar, [nH Unus, or any thi d pa (esueing ken wtalalion or ship- pO nI� � A ry C mCnt, a horn any pi "dud lk,iillty doh n5 of Holder or arty mirtl party. For this Limited 'vvanl nf,Y to apply, the Units must the installed k aepordanco V 0 - ` A 436 wA`i till sits caldifinng mVUired by stale and Indal cease', all OIl1F.I apUl�ca0le IdWS; and Irltllhata 5 fI1S;aXa4idn instrllcllGnS. lJi tv,n r¢preser�[auvH n! ud na3 the aili,nrly Ie change or H'„tend !hit. Lil nnCf_I Warrml!y. No warranty oK tai, to any early other then the Oriul- rral H� ' abtwe reprR,L y s true Slwtllhd lirnded Mi lani) oXlraid by Inf ltruta F. limitc9 n tl:e Ol ntal@y and c.owrties 4ava Uillererl warranty roWare- "Wrils_ Any pw s of LudS StvRdd WNW lnti'.trata'e C;orpaate Headquarter: in Old &rybro * C;Ornecliwl, pvire'to such purchase, to obtain a ropy of the appticahla warranty, aria should carelulty read that warranty priur to the purchase of Urlls. U S. Patents: 4,739, 661; 5,017,041; 5,156,488; 5,336.017; 5,4011,116: 5,401,459; 5,511 J03; 5,716,'163: 5,588,778; 5,839,844 Canadian Patents: 1,329,959: 2.004,5&3 Outer patents pending. I- liltraidr, Equalizer and &&Winder are registered trademarks of Infiltrator Systems Inc. Infiltrator 6 a rogiStererl trademark in France. Infiltrator,Syslems Inc. IS a r rygslered trademark .r. Mexico. Grntour, Contour Swivel Connection, MiooLeachinq, PofyTuff, S!api-ock, ChamberSoXii PosiLock, OuickCut. OuickPlav RECYCLEOOAVER 07/19/2005 08:27 7153862979 GLEN JOHNSON PAGE 02 �'j'Lt, /ZOOt 1[011 1 i !t vAl 713 316 4687 AT CACIS CO "0 OF DsHDp -- pC I� 2890P 446 UtMM a. van itmiffru or P= ST. Con Co,, vt STA BAA OF WMCONSIN FORM 1- 2000 awrW® na R@,'flRD WARRANWDRBD 97/1112M i11430 MI T1i S D made betwom Maacheew Inc., a M VA o f • C7utpot9do4 .and Glen Johnson Colladlt0doo, Ioa., a Miiaeseols M >RR1C iF'�: 19.p Grantor, for valuable C*69des dM � COnvcya to Grantee the following CWT a 337. dmmbad 'Welt in SL Quiz Coco% state of WlreonWa (the CC l Propac AG SEE ATTACEMD IMMIT A '^ Name and FAm Addmm* �•: imdTilleiuo. � . 1900 3i]vw Lake Road bitc 200 slla N �Mo Togetba i all apponmat rigbts, titic ad fcWotL 030.2131- 11l -000 �= � tdaulliatisa ►� c� Thin k= hommamd pmpWW. • Gnmtor w that tine ddg To dw Propcey is good, iadefeWble in fee eizaple and fRe and obw of camm umm GLOW a` Dated tlslaw of Jw�a 2MS. I NOR . i` ew . eG AUTHB,NTICA.TION AMMOVALEDGMPIT ;: .. slplecae(aj STATEMMI MOiA WASHiNOTON COUNTY. )1a. y, sn8nm6eatad Is 30tH day of JuM 200 Fammally caa m boibm me this 30 d4► of JwA 2005 the above pained Mot Jolumn , Ow Pmddmt of Man43ariet Homy, in0.. a MInnOaota Corpondon. tome known to be tM s. 1T11M. ER STATE BAR OF WISCONSIN pelaoe who e:eoutad tllse faza�ietg o,atraarnsst =A Utz aclmo+wl tlw aam A ? eatbo ' by 1 '706.06, WiL Ste ( v \ 6 M MUM EfT WAS DItAFM BY 'Atnnaw D. 7'hela Notary Publir, Mate of Minaesom etet�e .. � Mr ootmusabn B (1f trot, �pmtnon dui Jw Ammay, 1900 311vu Lake Rd #200, New �3r ) arl m 5 ANNEM D. THEIS (64"Wo am IN audwnti ad or mckr orkd6a t 04 on am mummy.) mNaes of oswo a YI mY amp�clly � M pro.i a pleoad t.lou �hdr i� 1y17t•f y Pl��tlfae41a1 fl Iaf10 07/19/2005 08:27 7153862979 GLEN JOHNSON PAGE 03 707/19/2009 K6m i e 5! rAR no 39i 4687 9T CROzz CO Rao 08 D8AD8 BOOS /00! I U. 2840P 44.7 EX =rr A LA 18, Stela' i Glee locgW in the Tom of St JaSq)k SL Croix CWW, WbwUi& STATE BAR OF WISCONSIN FORM 1 - 2000 Document Number WARRANTY DEED THIS DEED, made between Manchester Homes, Inc., a Minnesota Corporation, Grantor, and Glen Johnson Construction, Inc., a Minnesota Corporation Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin (the "Property"): SEE ATTACHED EXHIBIT A Recording Area Name and Return Address: Land Title Inc. 1900 Silver Lake Road Suite 200 New Brighton Mn 55112 Together with all appurtenant rights, title and interests. 030- 2131 -18 -000 Parcel Identification Number (PIN) This is not homestead property. Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except Dated this 30th day of June, 2005. �It�at1 ester Hom , C. * Gre o r ident AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF MINNESOTA ) WASHINGTON COUNTY. ) ss. authenticated this 30th day of June, 2005 Personally came before me this 30` day of June, 2005 the above named Greg Johnson , the President of Manchester * Homes Inc. a Minnesota Corporation, to me known to be the person(s) who executed the foregoing instrument and TITLE: MEMBER STATE BAR OF WISCONSIN acknowled d the same. (If not, Q authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY *Annette D. Theis Notary Public, State of Minnesota My commission is permanent. (If not, state expiration date: Larry Mountain, Attorney, 1900 Silver Lake Rd #200, New 6/30/2005 AAAAAAAAAAAA ) Brighton, MN 55112 ,>r ANNETTE D. THEIS (Signatures may be authenticated or acknowledged. Both are not necessary.) *Names of persons signing in any capacity must be typed or printed below their signature, Notary Public - Minnesota r:. °. M Common Ex Ina Jan 31, 2010 WARRANTY DEED STATE BAR OF WISCONSIN FORM No. 1 -2000 EXHIBIT A Lot 18 Settlers Glen located in the Town of St. Joseph, St. Croix County, Wisconsin. P , h' Wisconsin Department of Commerce SOIL EVALUATION REPORT Page / of, Division of Safety and Buildings in accordance with Comm 85, Ws. Adm. Code County , Attach complete site plan on paper not less than 812 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. ` �� percent slope, scale or dimensions, north arrow, and location and distance to nearest road. — 0 2 ( 3 t Please print all in rrriaan ° . -��' by Date Personal information you provide may be used for r/ purposes (Privacy Low, s. 15. (1) (m)). f(/fih Property Owner 2/ ? rope Location e D-r r i �TYx�S 1= +J u ` r vL of S W 1/43E 1/4 S Z 3 T 30 N R 2.0 E (or�W Property Owner's Mailing Add Lot # T n S ubd. Name or CSM# j A n! o nn ' Ilk 'V s 6 1 "e City State Zip Code Phone Number ❑ City ❑ village &Town Nearest Road R New Construction Use: Residential / Number of bedrooms 3 Code derived design flow rate GPD ❑ Replacement I ❑ Public or commercial - Describe: Parent material &J TL 4 S V Flood Plain elevation if applicable General oomments e y_4e yYl e (� 11 , y �$U 3 ��� (� •�`� and recommendations: ,Lon Ga o2 7�� (,mac ade 5 ZO 0 VU 1-11 Boring # ❑ Boring ❑pit Ground surface elev. `7 7 76 ft. Depth to limiting factor I 3 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. •Eff#1 •Eff#2 0- 31 5L Laaki f4 C5 ivy 2 _ 5L 2m5b< m r C s — `J `) 3 -i Iov 7 Boring # ❑ Boring F Ground surface elev.� R Depth to limiting factor I �$ in. ® Pi Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 5L 57 , 3 ,?s" �1' y -- a� i Effluent #1 = BOD > 30 _< 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD, < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature CST Number 2 5 33n9 Address Date Evaluation ducted Tel phone Number 2113 �N . Sanet� ,t�� 5 X402`3 � -/f ' o z C� c ��Z�7- 00 8 l 4 Property Owner f j2,E n . e- lk `� Parcel ID # Page of Boring [] Boring 3 4 ❑ Pit Ground surface elev. - �U ft. Depth to limiting factor ► 33 I Horizon Depth Dominant Color Redox Description Texture Structu a Soil Application Ra In. Mansell Qu. Sz. Copt Color _ - Consistence Boundary Roots GPDttt2 ., Gr. Sz. Sh. 'Eff#1 •EffN2 o -� to i .... �,a e l� 9 z i I - L 2xY)5 9 3 -J3 ? iU r y! cn�s S = 2 • l 0 , 2 F-1 Boring # Boring . ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rai Horizon Depth Dominant Color Redox Description.., .. Texture _Structure Consistence Boundary Roots Gpp /ft: In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff #1 'Eff#2 a I Boring # ❑ Boring ❑ Pit - Ground surface elev. ft. Depth to limiting factor in. Soil Application Rats Horizon Depth Dominant Color Redox Description Texture . Structure Consistence Bounda ry is Roo GP D ft : in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Elf #2 i - ' Effluent #1 = BODS > 30 < 220 mg/L. and TSS >30 < 150 ma • Effluent #2 = B0D < 30 mg/4 and TSS < 30 mg /l. The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608- 264 -8777. Sa687J0 (XO7aO) i PAGE_OF-3 NAME LOT# 115 LEGAL DESCRIPTIONS-✓ %SE 4 -S?-;5 T 3G N R ZO E(or) l SCALE: I"= qo BM 1 ELEVATION BM I DESCRIPTIO ° a� v c- 13M 2 ELEVATION BM 2 DESCRIPTION 1 SYSTEM ELEVATION SYSTEM TYPE CONTOUR ELEVATION �('b•ov - Yfov - ,60-0 ' Qd � d gZ U 2 SIGNATURE ATE F -2-d _cam ST CROItX COUNTY SEPTIC TANK MAIIV'I'ENANCE AGREEMENT AND OWNERSH P CERTIFICATION FORM O .Buyer - 6o1 bhrw-o.n Marking Addres � - Proporty Address / (Verification required from P Department for new construction) City/State Parcel Identification Number 030 off/ LEG AL DESCRIPTION Property Location St-0 % SE %,, Sec,),:�� T R W, Town of Subdivision ' C-,1a1 Lot # i Certified Survey Map # Volume . Page # Warranty Deed # -� q T � - 7 (o Volume 2 - , Page # Spec house ❑ yes 10 no Lot lines identifiable �j yes ❑ no SYSTEM MAMUNANCE Improper use and maintenanceof your septic system could result in its premature failure to handle wastes. Proper maintenance cots of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department.a certification form, signed by the owner and by a MSSW Phm3ber, Journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification Wing that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days o throe ar exp' tion date. SIGNATURE blyAPPLICANT DATE OWNER CERWICATION I (we) certify that all tatements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the d abov y virtue of a warranty deed recorded in Register of Deeds Office. SIGNATURE / s APPLICANT DATE s�ssss Any Wornsation that is mis- represented gray result in the sanitary permit being revoked by the Zoning Department. ss Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is in the warranty deed P'OWTS OWNER'$ MANUAL $ MANAGEMENT PLAN pa t of y pal HURV% "ATSOa Owner ST T 6"CIFfCAT1m Pugh a , Septic Tank Capacity ENNNEW� U __ �t is Septic Tank Manufacturer d NA $ rt'ERB Effluent Filter Manufacturer D NA Number of 9edrooms 9 q(3NA Effluent Filter Model d NA Number of Pub6o FacNky Unite. Pun+p Tank Capacity j a i a NA Estimated fbw lavera;eel Pump Tank Manufacturer r O NANq Design flow (peak), !Estimated x 1.51 Q slid Pump Manufacturer,, �/ t3 NA SON Application Rate l da. O PUMP Model ��IS 6 L7 NA Standard MNuent/Effluent ouslity Monthly averape Pretreatment Unit A Fats, Oil A Grasse IFOG) 530 mg /L D Bend /Gravel Filter O Peat Fitter 9100 emkcal 0XV9en Oemand 1000 5220 mg /L 0 NA Q Meohanicai Aeration © Wetland Total suspended Solids (TSS) 51 EO mail p Disinfection p O Pretreated Effluent Quality MontMy ever$ge A Wls) 0 NA Siochemicsl Oxygen Demand 1000 S30 mg /L Ground (gravity) 0. In- Ground (pressurized) Total Suspended Solids (TSS1 S30 mg /l. 13 At -Grade O Mound Fecal Colitorm lgeometNc means si q Drip -Line 0 Oder: Maximum Effluent Particle Size K in dig, Q NA O NA Other: D NA to NA a Voluss typical for dornsstic Wawwater and septic tank offksnt. OIW: Q NA MAINTINA1401 6CffMLE serAft Event Ssrvioe Frequency Inspect condition of tank(a) At least once every ; 3 �, s (Mwdewnn 3 years) C3 NA Pump out contents of tanks) When combined sludge and scum equals one -third (Y9) of tank volume O NA Inspect dispersal calf( At lent once ovary: C mor4h(S) (Maximum 3 years) 17 NA monil Clean effluent fikar — At leer* once awry. a A NA Inspect pump, pump controls iii alarm At least once every: e O NA O s} flush laterals and pressure toot At [asst once every: al Q NA At lea+wt once evK .r- monthts) 0 NA Other: Q NA MANT'ViAWE IN$TRUCTx)Ns Inspections of tanks and dispersal cells shall be made by an Individual carrying one of the following ricsnesa or certifications: Master Pkrmber; Master PlurrAmr Rostricuw Sewer; POW'TS Inspector; POW S Maintolner, Septage Servicing Operator. Tank inspections must include a visual Inspection of the tank(;) to identify any missing or broken hardware, identify any cracks or looks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal uii(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground ov0sca may Indicate a failing condition and requires the immediate notification of the local regulatory authority. When the oombkwd accumulation of sludge and scum in any tank equals one -third lYs) or more of the tank volume, the entire Contents of the tank shad be removed by a Samoa Servicing Operator and disposed of in accordance with chapter NR 113, WisconsM Administrative Code. All other Cervices, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Molntakw. A service report shall be provided to the local regulatory authority within 10 days of completion of env service event. Page o t ?/ START UP AND OPERATION For now construction, prior to use of the POWTS check treatment tanklsl for the presence of painting products or other oharnmcai that may impede the treatment process and /or damage the dispersal celf1a), if high concentrations are detected have the contents of the tank(*) removed by a septa" servicing operator prior to use. System start up shall not occur when soil conditions are froxen at the Infiltrative surface. During power outages pump tanks may till above normal highwatsr levels. When power is rostored the excess wastewater will be discharged to the dispersal califs) In one large dose, overloading the osil(s) and may result in the backup or surface discharge of effluent. To avo this situation h ave the contents of the pump tank removed by s Septage Servicing operator prior to restoring power to the effluent pump or contact a Plumber or P OWTS Mointsiner to ass ist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down Slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of t" POWTS: antibiotics; baby wipes: cigarette butts; condoms; cotton swabs; degressers: dental floss; diapers; disinfectants; f e,t foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meet scraps; rnedicatiorls; cal; painting products; pesticides; sanitary napkins; tampons; .and water softener brine. ASANDONMWT When the POWTS falls and /or is permanently taken out of service the following steps shall be taken to insure that the svmeri s properly and safely abandoned In compliance with Chapter Comm 83.33, Wisconsin Administrative Code: e All piping to tanks and pits shsl( be disconnected and the abandoned pipe openings sealed, s The contents of all tanks and pits shall be removed and properly disposed of by a Sectage Servicing Operator. e After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material, CONTINGENCY PLAN li the POWT , 64 alls and cannot be repaired this following measures have been, or must be taken, to provide a cods compliant replaoem system; A suitable replacement area has been evalusted a nd may be utilized for the location of a repl acement soil absorption system. The replacement area sho uld be protected from disturbance and compaction and shouid not be Infringed upon t;y required setbacks from existing and proposso structure, lot lines and wolfs. Failure to protect the replacement area w4` result In the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time., Q A suitable replacement area Is not e d u e to setback and /or soil limitations. Barring advances in POWTS technot"y a holding tank may be Installed as a last resort to replace the failed POWTS, if site e task C3 Mound and at -grade Soil absorption systems may be reconstructed in place following removal of the blomat at th(; infiltrative surface. Reconstructions of such syat'SMS must comply with the rules In effect at that time. < < WAANiNG > > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. 00 NOT ENTisR A SEPTIC, PUMP OR OTHER TREATMENT TANK uNDgR ANY CIRCUMSTANCES. DEATH MAY RESULT, RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DI FF ICULT OR IM POIisIiglLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTA INGR Name 1, Q, `fr r=( f, ► s Q Jr Now Phone 7 Phone SEPTA43E SERVICING OPERATOR (PUMPER) OCAL UILATORY AUTHQRITY r Name Nettle Phone Phone - 0 t 2 S. 3X& lrl� This document was drafted in carnphonca with chapter Comm 93.2212llb}II)fd) &(f) and 83.54411, (1) & (3). Wisconsin Administrative Code, • A r�� .- 3'000 SQ FT. \ \ \ cv 130, D RAINAG E sr 4 b 1 . � . Fp`SEME • LOT 1 'a 2A E S RE C 3.00 FT Cyr \ 130, SO \ � \ L.= 1. B G = ' 0 � ' \ LOT 18 \ \ s 3 ArRES 100, s Q / O 759 'L r, \ 30, 7► s.1 O [ NAL o . 'c� \ \ 110 .\ 21Y RECR 7 0. \mss EN \ TRAIL •� �4K� Qs\ L B p. =866.0 \ / �• Q� �n / 17 k � T O \' \ / moo. 1 ASS \� 3.00 �. 130.72 SO- LOT 16 � \ 3 000 A CRE \ 130. SQ• r \ IFIED AND ACTING \ CONSERVA110"\ . �+ THAT THE \ � \ CERTIFY AND NO UNPAID c��\ � ' "IAX ES AFFECTING \ \{�• r \ :: E >�i. \ •r ,.,� �` '—$ — s �1 ►��3St�1,�C1J141Ri1L�L�iC_3�3ts - _-------- - --$•_ . ONA TFALEASEMENT - - _ __ _. —_.- _._ --- --- — �Y4�yYK10►a�NnON .a IL/► ME . — . ....................... .... . ••— ••— .... ... i91 11N►1izi1 aswmN.aDU — . .. . ..... . .. . .. — —« ST. J G — .. —.._ . —.. —.. LOT 6 & LOT 7 3 00. F 3.000II F t30.ee36o.Fr. 13o.aexso.Fr. .••�.�'' � s� �� ��yq.a19 S aaoenw LOT 6 3.000 ACRES LOT 8 130,08080. FT. &000 ACRES AC C 130.000 80. Fri I � rm ' _ � "'• •..• ................... .arm -ate M.WA -1 -803. \ LOT 9 _— t3oem SCI. Fr. 1 ; rr �\ LOT4 ` —�—' -- 3A00 NCPEB _ . L e O .o06A 8A00 ACRES - 130,000 80. Fr. i L0.0. -906.0 1aD,ea1 80. Fr. H.W.L. -003.0 i eAlertElvr H 1 .................................... /.............................. p H,WA- -803.0 \\ 1 / ' DRMNACIE 1 `�,' •+gyp,,_\ �•�` �t� �\, \\ � / / EASBABrr 1 LOT *I 10 1 IAO1 ACRES ` \* /* p. ►tw L-ao3 0 1 130.11 eo Fr. L8.0. -806.0 �.�\ '��♦ v i / m """'+►+iii #•.. i ... r LOT 20 w iA01 m...�\� H.WL -8000 % � i K 1I0.73/8d Fr. LOf./11 • I •.' \\\`� ``' \SI 3. AOFES SO. Fr. 4�p -8000 \ `s� 1/ 1 LOT 16 ORABdAW O ' /.. ` 3 002 ACtiEB \ l l LOT 12 I L 180.707 80. FT. \ 3 000 /uCASS c � � teoe90 ea Fr. Y .ti ��, L.D.O. -S6S.0 \ � .'' '\ • \\ H.W.L -903.0 � I \,N \ \ I \ \ LOT ` \ ♦\ `fin 3.002 ACRES ♦ ♦ \7, 130.769 30. Fr. I v ate» \d LOT 13 I q` \ \'\ � % \� +7 \•\ EA it ( 1 k000 Fr i 9 LOT 17 \w "mama. . 1. ....... E '� • 101D80M�>r •acumWIPRAMMEeO n \ \\ ! '\ LOT 1d / � STATE vISCONSIO `\ ` ♦ yi. iii. j \ CWN1V Ol' Sf. CRODOSS ` /aaota+� — $a ` I, CHORML A (1001. WW TW n ED FT Lr ELECT. QUALVIED AND ACTH \ 7 T8!AS= Or ST. CR= COI►f. DO NErtoT CERTI'Y THAT THE \ ••. \\ t. - :� E pprr'.` RfCWS IM W OFFICE SNOV w UMIEDEDED TAX SALES AND TAKES `\'' •. 0Mr•NATON \. F at AS SFELIAt ASSttt/0(1S OF t THE LAND OiQJIDEa I TTIE FI, �T t>i SE CiE1M1 DATE \ \ : ''' coERir7 T `� •., ` ? \ w Ir c ' 80AL! w FIST SHEET 3 OF 5 s,. N' 07/19/2005 08:27 7153862979 GLEN JOHNSON PAGE 01 Po 9m Hudson. W15W16 Gl Joh OIL - 15.906 -Z9'!4 Fax - 71 2979 Constructi F" *Oa �aoflle S Ap8Q ors 7 q ICK X urv0 For "WOW ❑ Gott Q ""m Reply 0 M"" Rocyaw Mot,-r� � Ck V � S 6Lw-, fit I5 w f"u COLP oQ '}�) rt c Oo SE�f'\ cab Lka - 1 ►l::�- 38C. - a T79 . p o�